Healthcare Provider Details

I. General information

NPI: 1477272391
Provider Name (Legal Business Name): MEGAN FERNANDEZ LCSW-CC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2022
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 WOODSIDE DR
KENNEBUNK ME
04043-7344
US

IV. Provider business mailing address

7 WOODSIDE DR
KENNEBUNK ME
04043-7344
US

V. Phone/Fax

Practice location:
  • Phone: 207-423-4095
  • Fax:
Mailing address:
  • Phone: 207-423-4095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberMC19121
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: